• Journal of the Korean Arthroscopy Society
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• v.14 no.1
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• pp.7-12
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• 2010

Purpose: To evaluate the effects of total or subtotal meniscectomy on anterior cruciate ligament reconstruction. Materials and Methods: We reviewed the 455 cases of arthroscopic ACLR (anterior cruciate ligament reconstruction) from February, 2003 to February, 2007 and followed-up more than 1 year. The 93 cases were enrolled. The 45 cases who underwent only ACLR were included and the 48 cases who underwent ACLR with total or subtotal meniscectomy were included in this study except grade 3 or 4 chondral lesion, partial meniscetomy or meniscal repair. We divided the patient into 4 groups which were isolated ACLR group (group I, 45cases), ACLR with lateral meniscectomy group (group II, 10cases), ACLR with medial meniscectomy group (group III, 28cases) and ACLR with both medial and lateral meniscectomy group (group IV, 10cases). The clinical evaluation was done by range of motion (ROM), IKDC subjective score, Lysholm score, anterior drawer test, Lachman test, Pivot shift test and KT-1000 arthrometer. Results: At final follow up, group IV was inferior than group I in IKDC subjective score and Lysholm score, and inferior than group II in IKDC subjective score. In KT-1000 arhtometric test, group I had better results than group III and group IV. Also in anterior drawer test and Lachman test, group 1 had better result than group III and group IV. In pivot shift test, there was no significant difference among four groups. Conclusion: Medial or both medial and lateral meniscectomy had greater laxity in anterior drawer test, Lachman test and KT-1000 arthrometric test and both medial and lateral meniscectomy had a lower subjective score than both meniscus intact group.

• Journal of the Korean Arthroscopy Society
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• v.12 no.1
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• pp.18-23
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• 2008

Purpose: The purpose of this study is to evaluate the clinical results of the function and stability of ACL reconstruction using the flexible reamer. Materials and Methods: We reviewed 98 patients who taken ACL reconstruction using the flexible reamer from March, 1999 to May, 2004. And the follow-up period was more than 12 months in all cases. We used the subjective tests including Lysholm knee score and 2000 International Knee Documentation Committee(IKDC) subjective knee score, and the objective tests such as anterior drawer test, Lachman test, pivot shift test, and KT-2000 arthrometer to evaluate the clinical results. Results: In the range of motion of the affected knee, the extension deficit more than 5 degree was 8 cases preoperatively and 1 case postoperatively. The flexion deficit more than 5 degree was 12 cases preoperatively and 2 cases postoperatively. The mean Lysholm knee score was 61.3 point(${\pm}3.5$ SD) preoperatively and 87.7 point(${\pm}2.0$ SD) postoperatively. The mean 2000 International Knee Documentation Committee(IKDC) subjective knee score was 49 point(${\pm}3.3$ SD) preoperatively and 84 point (${\pm}2.2$ SD) postoperatively. 93 cases were more than grade II in Lachman test preoperatively and 5 cases postoperatively. 71 cases were more than grade II in pivot shift test preoperatively but 89 cases were negative postoperatively. The mean maximal manual difference by KT-2000 arthrometer was 6.8 mm(${\pm}1.9$ SD) preoperatively and 1.8 mm(${\pm}0.8$ SD) postoperatively. Conclusion: ACL reconstruction using the flexible reamer achieved the ideal isometric point of femur and anatomic graft placement, so we could obtain good results, especially in rotational stability.

• Journal of the Korean Arthroscopy Society
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• v.11 no.2
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• pp.111-116
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• 2007

Purpose: To assess the clinical results of ACL reconstruction with a fresh frozen Achilles allograft, retrospectively and the findings of the graft in second look arthroscopy. Materials and Methods: Twenty-eight ACL reconstructions using fresh frozen Achilles tendon allograft were included in this study between March 1999 and February 2003. The average age was 31.2 years old and the average follow-up was 16.6 months(range: 12-26 months). The clinical evaluation was done by KT-1000 arthrometer, Lysholm knee score, range of motion, Lachman and pivot-shift test. Results: In the last follow-up of Lachman test, 21 cases showed normal, 5 cases grade 1, 2 cases grade 2 and 1 case grade1. The results of pivot-shift test data, 23 cases(82.1%) were normal, 4 cases(14.3%) grade 1, 1 case(3.6%) grade 2. The mean maximum side-to-side difference was improved from 6.75mm preoperatively to 2.46mm in the last follow-up. Lysholm knee score was improved from 73.5 preoperatively to 91.6 in last follow-up. Re-rupture of the ACL graft was found in one case and one case of wound infection in the tibial incision was found. The 6 cases showed the good synovialization of the ACL graft. Conclusion: The anterior stability was restored with ACL reconstruction using fresh frozen Achilles allografts and the good synovialization was found in the second-look arthroscopy

• Journal of the Korean Arthroscopy Society
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• v.10 no.2
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• pp.209-213
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• 2006

Purpose: Conventional transtibial approach for the anterior cruciate ligament (ACL) reconstruction tended to place the femoral tunnel in too vertical position (11 or 1 o'clock), which could provide the postoperative anteroposterior (AP) stability but not provided the rotational stability. Therefore we present a surgical technique to make the transtibial femoral tunnel at 10 or 2 o'clock position. Surgical approach: To make a transtibial femoral tunnel at the 10 or 2 o'clock position, the direction and position of the tibial drill guide was important. We set the tibial drill guide at $40{\sim}45$ degrees and the intraarticular guide tip was 1 mm anterior and medial to the conventional site. The starting point for the guide pin on the proximal tibia was proximal to the pes anserinus and anterior to the medial collateral ligament. The tibial tunnel was initially drilled 1mm less than the diameter of the graft. Then femoral offset guide could be easily placed at 10 or 2 o'clock position through the tibial tunnel. The tibial tunnel and the femoral tunnel of 30 mm in length were made with the reamer that was same size with the graft. Conclusion: We report a surgical technique to create a transtibial femoral tunnel at 10 or 2 o'clock position in ACL reconstruction to provide the rotational stability as well as the AP stability.

• Journal of the Korean Arthroscopy Society
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• v.15 no.1
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• pp.1-6
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• 2011

Purpose: The purpose of this prospective study is to compare the results of arthroscopic reconstruction of ACL using autologous hamstring tendon (Group 1) and autologous bone patella tendon bone (Group 2). Materials and Methods: From Jan. 2004 to Dec. 2007, fifty patients were analyzed in this study. A single surgeon performed the ACL reconstruction with autologous hamstring tendon (25 patients) and autologous bone patella tendon bone (25 patients) alternatively each other. The mean follow up period of two groups was 38 months (range 25~58 months). We evaluated the result of Lachman test, Pivot shift test as a physical examination and Lysholm score, Tagner activity scale as patients' satisfaction and functional status and Telometer for anterior instability of each groups at the time of final follow up. Results: In final results, negative or mild positive findings on Lachman test were 24 out of 25 cases (equally) in each groups.) Twenty two cases in the Group 1 and 21 cases in the Group 2 were negative on Pivot shift test. Lysholm scores mark 94.6 points in group 1 and 92.3 points in group 2 at the final follow up and Tegner activity scales mark 8.5 points (Group 1) and 8.1 points (Group 2) at the time of last follow up and there were no differences between the two groups statistically. The numbers of patients who have less than 5 mm of anterior translation of tibia under telometer at 20 degrees of knee flexion are 24 cases in group 1 and 23 cases in group 2. Conclusion: The overall improvements of clinical scores (Lysholm scores and Tegner Activity scales) of the group 1 were a little bit superior to those of the group 2, but there were no significant statistical difference between two groups.

• Journal of the Korean Arthroscopy Society
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• v.8 no.2
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• pp.89-93
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• 2004

Purpose: To evaluate the clinical stability and function after arthroscopic anterior cruciate ligament(ACL) reconstruction using fresh-frozen tibialis tendon allograft. Materials and Methods: Of the patients who underwent ACL reconstruction using tibialis tendon allograft from July 2002 to June 2003, thirty-one patients could be evaluated and the mean follow-up period was 19 months. Evaluations included were Lysholm knee score, 2000 International knee Documentation Committee (IKDC) subjective knee score, Lachman test, pivot shift test, KT-1000 arthrometer measurement and 2000 IKDC knee examination. Results: The mean Lysholm score was 88. Twenty-eight patients (90.3%) were good or exellent for the measured parameters. Twenty-seven patients(87.1%) was over 70 in IKDC subjective knee score. Thirty patients (96.8%) had 1+ firm end or negative Lachman test. 27 patients (87.1%) had a negative pivot shift. Thirty patients (96.8%) had less than 5mm difference of maximal manual difference by KT-1000 arthrometer. Twenty -nine patients (93.5%) were nearly normal or normal grade by 2000 IKDC knee examination. Complications were 1 case of failure and 1 case of infection. Conclusion: ACL reconstruction with the double-stranded fresh-frozen tibialis tendon allograft resulted in a reliable and predictable outcome after short-term follow-up.

• Journal of Korean Foot and Ankle Society
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• v.22 no.2
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• pp.55-61
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• 2018

Chronic lateral ankle instability is a major complication of acute ankle sprains, which can cause discomfort in both daily and sports activity. In addition, it may result in degenerative changes to the ankle joint in the long term. An accurate diagnostic approach and successful treatment plan can be established based on a comprehensive understanding of the concept of functional and mechanical instability. The patients' history and correct physical examination would be the first and most important step. The hindfoot alignment, competence of the lateral ligaments, and proprioceptive function should be evaluated. Additional information can be gathered using standard and stress radiographs. In addition, concomitant pathologic conditions can be investigated by magnetic resonance imaging. Conservative rehabilitation composed of the range of motion, muscle strengthening, and proprioceptive exercise is the main treatment for functional instability and mechanical instability. Regarding the mechanical instability, surgical treatment can be considered for irresponsible patients after a sufficient period of rehabilitation. Anatomic repair (modified $Brostr{\ddot{o}}m$ operation) is regarded as the gold standard procedure. In cases with poor prognostic factors, an anatomical reconstruction or additional procedures can be chosen. For combined intra-articular pathologies, arthroscopic procedures should be conducted, and arthroscopic lateral ligament repair has recently been introduced. Regarding the postoperative management, early functional rehabilitation with short term immobilization is recommended.

• Journal of Korean Orthopaedic Sports Medicine
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• v.5 no.1
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• pp.45-49
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• 2006

목적: 자가 골-슬개건-골과 슬괵건을 이용한 전방 십자 인대 재건술의 5년 중기 추시 결과를 비교 분석하고자 한다. 대상 및 방법: 전방 십자 인대 재건술을 시행한 후 5년 이상 추시 관찰이 가능한 65예를 대상으로 하였고, 골-슬개건-골이 38예, 슬괵건이 27예였다. 술 후 평가는 Lysholm 점수, 관절 운동 범위, 대퇴부 중간 부위 둘레 길이, Lachman 검사, 축 이동 검사, KT 2000 관절 계측기를 시행하였고, 술 후 합병증을 평가하였다. 결과: Lysholm 점수는 골-슬개건-골군과 슬괵건국에서 각각 평균 91점, 94.2점으로 슬괵건군이 우수하였고, 대퇴부 중간 부위 둘레 길이는 건측에 비해 각각 평균 1.7cm, 1.3cm의 차이를 보였다. 양 군간에 관절 운동 범위, Lachman 검사, 축 이동 검사 및 KT 2000 관절 계측 결과는 통계적으로 유의한 차이가 없었으나, 술 후 합병증은 과도한 보행이나 운동 후 슬관절 동통이 골-슬개건-골군에서 7예, 슬괵건 군에서 4예 관찰되었고, 전방 슬관절 동통이 골-슬개건-골군에서 4예 관찰되어, 골-슬개건-골군에서 더 많이 발생하였다. 결론: 5년 중기 추시에서 자가 슬괵건군이 우수한 슬관절 기능, 적은 합병증 등 임상적으로 우수하였으나 장기 추시가 요할 것으로 사료된다.

• Perspectives in Nursing Science
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• v.2 no.1
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• pp.19-36
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• 2005

Muscle atrophy is defined as a decrease in muscle mass, cross-sectional area, and myofibrillar protein content. Causes inducing muscle atrophy may be inactivity, denervation, undernutrition and steroid. Inactivity may decrease protein synthesis and increase protein breakdown of skeletal muscle. The muscle atrophy due to inactivity was induced by bed rest, hindlimb suspension, cast, total hip replacement arthroplasty, anterior cruciate ligament reconstruction. Denervated atrophy may be induced by the loss of innervation from lower motor neuron. The atrophy was apparent in the lower limb of hemiplegic patients following ischemic stroke and in the hindlimb of ischemic stroke rats. Protein breakdown of skeletal muscle in the undernourished state results in muscle atrophy. The atrophy due to undernutrition was evident in cancer and leukemia patients and in the undernourished rats. Steroids have been used to treat allergies, inflammatory diseases, autoimmune diseases and to inhibit immune function following transplantation. Steroids may induce muscle atrophy by protein breakdown of skeletal muscle. Muscle Physiology Laboratoryat College of Nursing, Seoul National University proved that dexamethasone may induce hindlimb muscle atrophy in rats and exercise and DHEA may attenuate hindlimb muscle atrophy induced by the steroid in rats. Nurses working with patients undergoing steroid treatment need to be cognizant of steroid induced muscle atrophy. They need to assess whether muscle atrophy is being occurred during and after the steroid treatment. Moreover, they need to apply exercise and DHEA to the patients undergoing steroid treatment in order to attenuate the steroid induced muscle atrophy.

• Journal of the Korean Arthroscopy Society
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• v.1 no.1
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• pp.123-127
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• 1997

Arthroscopic anterior cruciate ligament reconstructions using bone-patella tendon-bone have been considered the best method by which others are compared. The notchyplasty is one of the important steps of this procedure and it is emphasized recently to prevent retear of the reconstructed ACL caused by impingement. However, until now, there is controversy about adequate amount of notchyplasty. Also, it is hard to examine the adequacy of notchyplasty even in the arthroscopic field, The purpose of this paper is to describe the surgical technique of notchyplasty, using the flexible reamer and preliminary result of its operation. In this study the results of ACL reconstruction with notchyplasty which is made by us were analized from January. 1994 to December, 1995. The results were as follows: 1. The notchyplasty with flexible reamer is the method that can be obtained adequate amount of removal, perfectly smooth notchyplasty. 2. The range of motion of the affected knee joint was normal ROM after post operation 6 month. 3. In the last follow up, 2 cases were positive in anterior drawer test 4 cases were positive in Lachmann's test and 1 knee was positive in Pivot shift test 4. Average Lysholm knee scoring scale was 70 points at preoperative and 92 points at the last follow up.